Gaining all weight back! Failed band results!

 I am a 60 year old male. I'm 5'9" and weighed 250 lbs before the surgery, just barely qualifying for the insurance limit to have the surgery. It's been almost 5 years since my lap-band surgery. After blaming myself for failed results, I have come to the conclusion that the operation was not successful. I was told my cravings would become less. I was told I would feel full sooner and more often. I was told many things but they are not working for me. After surgery, I lost about 40 lbs in a couple months. Everything was great. I did gain back about 10 lbs, but that was okay. Without telling me beforehand, the surgeon told me later that he used a smaller band on me as an "experiment", hoping I would need fewer adjustments. He then decided to go back to his old method for some reason. I never lost anymore weight after that. And, in fact, despite my efforts, have gained much of it back. The surgery was supposed to alter some hormones and affect my appetite and fullness. It did neither. I've had 5 adjustments in 4 1/2 years, because the smaller band allowed for fewer adjustments and the adjustments helped for about a week. My cravings have gone off the charts! I never feel full, even long after I have filled my pouch. (I have never vomited in my life, and still have not.) I excercise to the point where numerous doctors have told me to slow down. (I walk about 4-9 miles per day and do many calesthenics.) My cravings are so much worse now than before the surgery. I have been told it's about the hormones and the surgery didn't do what it was supposed to do about them. I start a new diet about every other month but continue to gain weight. My diabetes is back, my blood pressure is up, and weight loss is so much more difficult than pre lab band. To top it off, after my 2nd adjustment, I haven't been able to burp. Not at all! Not once! No vomiting, no burping, very uncomfortable. I am wondering how many others have had these kinds of experiences since there surgery. I'm open to suggestions. Thanks.

So sorry Mark for what you have dealt with. Before you focus on anything else here, please stop and go see your doc to get a slight unfill. I do not know the size of your adjustments but an unfill as small as .1 mm can make a difference. Please.. pain is an indicator of something wrong. if you get it fixed now, you risk less permanent problems. While you're there, a checkup with your nutritionist wouldn't hurt. Hugs and welcome here...you CAN turn your failed band around. For me, that is the beauty of the band: the ability to restart.


ETA: Well, crap..it IS Saturday ...doubt your doc is open....but if your doc is like mine, he would want you to call him in a situation like this.

 Hi Mark,

The real issue is that the doctors should not be banding people over 50. There is a new report that suggests this. Many are suffering from "Esophagus dismotility". All the best to you.

 Do you know what "Esophagus dismotility" is? Thanks.

On February 29, 2012 at 11:35 AM Pacific Time, markteach wrote:  Do you know what "Esophagus dismotility" is? Thanks.

The esophagus functions solely to deliver food from the mouth to the stomach where the process of digestion can begin. Efficient transport by the esophagus requires a coordinated, sequential motility pattern that propels food from above and clears acid and bile reflux from below. Disruption of this highly integrated muscular motion limits delivery of food and fluid, as well as causes a bothersome sense of dysphagia and chest pain. Disorders of esophageal motility are referred to as primary or secondary esophageal motility disorders and categorized according to their abnormal manometric patterns. See the images below.
 

Anatomy

The tubular esophagus is a muscular organ, approximately 25 cm in length, and has specialized sphincters at proximal and distal ends. The upper esophageal sphincter (UES) is comprised of several striated muscles, creating a tonically closed valve and preventing air from entering into the gastrointestinal tract. The lower esophageal sphincter (LES) is composed entirely of smooth muscle and maintains a steady baseline tone to prevent gastric reflux into the esophagus.

The body of the esophagus is similarly composed of 2 muscle types. The proximal esophagus is predominantly striated muscle, while the distal esophagus and the remainder of the GI tract contain smooth muscle. The mid esophagus contains a graded transition of striated and smooth muscle types. The muscle is oriented in 2 perpendicular opposing layers: an inner circular layer and an outer longitudinal layer, known collectively as the muscularis propria. The longitudinal muscle is responsible for shortening the esophagus, while the circular muscle forms lumen-occluding ring contractions.

Esophageal peristalsis

The coordination of these simultaneously contracting muscle layers produces the motility pattern known as peristalsis. Peristalsis is a sequential, coordinated contraction wave that travels the entire length of the esophagus, propelling intraluminal contents distally to the stomach. The LES relaxes during swallows and stays opened until the peristaltic wave travels through the LES, then contracts and redevelops resting basal tone. Low peristaltic amplitudes normally occur at the transition zone between the striated and smooth muscle portions; however, the peristalsis is uninterrupted.

Primary peristalsis is the peristaltic wave triggered by the swallowing center. The peristaltic contraction wave travels at a speed of 2 cm/s and correlates with manometry-recorded contractions. The relationship of contraction and food bolus is more complex because of intrabolus pressures from above (contraction from above) and the resistance from below (outflow resistance).

The secondary peristaltic wave is induced by esophageal distension from the retained bolus, refluxed material, or swallowed air. The primary role is to clear the esophagus of retained food or any gastroesophageal refluxate.

Tertiary contractions are simultaneous, isolated, dysfunctional contractions. These contractions are nonperistaltic, have no known physiologic role, and are observed with increased frequency in elderly people. Radiographic description of this phenomenon has been called presbyesophagus.

Esophageal motility disorders

Esophageal motility disorders are not uncommon in gastroenterology. The spectrum of these disorders ranges from the well-defined primary esophageal motility disorders (PEMDs) to very nonspecific disorders that may play a more indirect role in reflux disease and otherwise be asymptomatic. Esophageal motility disorders may occur as manifestations of systemic diseases, referred to as secondary motility disorders.

Esophageal motility disorders are less common than mechanical and inflammatory diseases affecting the esophagus, such as reflux esophagitis, peptic strictures, and mucosal rings. The clinical presentation of a motility disorder is varied, but, classically, dysphagia and chest pain are reported. In 80% of patients, the cause of a patient's dysphagia can be suggested from the history, including dysmotility of the esophagus. Before entertaining a diagnosis of a motility disorder, first and foremost, the physician must evaluate for a mechanical obstructing lesion.

Esophageal motility disorders discussed in this article include the following:

• Achalasia
• Spastic esophageal motility disorders, including diffuse esophageal spasm (DES), nutcracker esophagus, and hypertensive LES
• Nonspecific esophageal motility disorder (inefficient esophageal motility disorder)
• Secondary esophageal motility disorders related to scleroderma, diabetes mellitus, alcohol consumption, psychiatric disorders, and presbyesophagus

Next Section: Pathophysiology

Esophagus

After food is chewed into a bolus, it is swallowed and moved through the esophagus. Smooth muscles contract behind the bolus to prevent it from being squeezed back into the mouth. Then rhythmic, unidirectional waves of contractions will work to rapidly force the food into the stomach. This process works in one direction only and its sole purpose is to move food from the mouth into the stomach.^[2]

In the esophagus, two types of peristalsis occur.

AA simcplified image showing peristalsis

• First, there is a primary peristaltic wave which occurs when the bolus enters the esophagus during swallowing. The primary peristaltic wave forces the bolus down the esophagus and into the stomach in a wave lasting about 8–9 seconds. The wave travels down to the stomach even if the bolus of food descends at a greater rate than the wave itself, and will continue even if for some reason the bolus gets stuck further up the esophagus.
• In the event that the bolus gets stuck or moves slower than the primary peristaltic wave (as can happen when it is poorly lubricated), stretch receptors in the esophageal lining are stimulated and a local reflex response causes a secondary peristaltic wave around the bolus, forcing it further down the esophagus, and these secondary waves will continue indefinitely until the bolus enters the stomach.

Esophageal peristalsis is typically assessed by performing an esophageal motility study.

Good Luck with your research and if there is anything I can help you with please feel free to ask me.

Lisa
www.obesityhelp.com/group/failed_lap_bands/

 

  http://emedicine.medscape.com/article/174783-overview

 I keep coming back to your post,  Mark. Maybe it is because that is my hubby's name too ( and grown son's) so I hate to see a Mark suffering.    ...  Anyway, it really sounds like your doctor should have used this smaller band on a smaller person.  I am a 5'3" female with a small frame and my doc decided to use the smaller 10mm band on me ( what size is yours?). because of my inside anatomy. 
Unless you are a smaller than average male, my doctor would not have used a smaller band on you.


Btw,  I was banded about 18 months ago and lost about 40 lbs quickly and the rest slowly since then...if you average it over a 6 month period, I am losing 1-2 lbs a month.

 I'm not sure about the size, I just know that AFTER the surgery he told me he tried a smaller band on my but that he was going back to the larger sized. He never told me why. I guess I'm going to have to try  harder. Thanks.

If he documented that in your chart then he should be willing to write a very nice letter to your insurance company stating this and asking them to approve you for a revision to another WLS. Since that isn't going to happen, you need to get a complete copy of your medical records before bringing this up to him. I doubt he documented his " experimentation " on you, but if he did...then you can use this information to help you.

Did he inform you of his unauthorized experimentation or did you sign an informed consent for his little project ?